The Coming Decline of Hospitals and Implications for Our Strategic Plan

Consider this: What year saw the maximum number of hospitalizations in the United States? The answer is 1981.

That might surprise you. That year, there were over 39 million hospitalizations — 171 admissions per 1,000 Americans. Thirty-five years later, the population has increased by 40 percent, but hospitalizations have decreased by more than 10 percent. There is now a lower rate of hospitalizations than in 1946. As a result, the number of hospitals has declined to 5,534 this year from 6,933 in 1981.

In addition to the impact of increasing infection risks:

The number of hospitals is also declining because more complex care can safely and effectively be provided elsewhere, and that’s good news.

When [the writer] was training to become an oncologist, most chemotherapy was administered in the hospital. Now much better anti-nausea medications and more tolerable oral instead of intravenous treatments have made a hospital admission for chemotherapy unusual. Similarly, hip and knee replacements once required days in the hospital; many can now be done overnight in ambulatory surgical centers. Births outside of hospitals are also increasing, as more women have babies at home or at birthing centers.

Studies have shown that patients with heart failure, pneumonia and some serious infections can be given intravenous antibiotics and other hospital-level treatments at home by visiting nurses. These “hospital at home” programs usually lead to more rapid recoveries, at a lower cost.

This has huge implications for the system as a whole.

As these trends accelerate, many of today’s hospitals will downsize, merge or close. Others will convert to doctors’ offices or outpatient clinics. Those that remain will be devoted to emergency rooms, high-tech services for premature babies, patients requiring brain surgery and organ transplants, and the like. Meanwhile, the nearly one billion annual visits to physicians’ offices, imaging facilities, surgical centers, urgent-care centers and “doc in the box” clinics will grow.

It also has huge implications for our already well-advanced planning for implementation of our strategic goals with respect to health care at Collington. For example:

It will become possible for more and more of us to be treated for more contiditions as outpatients.

Our skilled nursing units will have new uses as lower levels of care during treatment are appropriate.

Potential medical system partners will become even more interested in Collington as “off-site partners.”

The need for focused research on the impact of these changes will be greater, making the appeal of a research friendly partner even greater.

Integration of our holistic services with broader service networks will become crucial and practical.

In other words, we are moving toward “modern gerontology” at just the point that other systems will need our partnership.

A very timely commentary given that we are about to start the implementation phase of our 2018 Strategic Plan. So the mental model is the outward movement of medical services which will be held together by three evolving systems : at home nursing ; real time information availability; and live monitoring technology . ” At home nursing is not an evolving system; we have had it for years and it often looses money ” I hear you say !!! From my view point progress with information management and live monitoring will continue and we will adopt in a gradual fashion. But “at home nursing” needs a substantial rethink if it is to be effective at the required new level of complexity AND for it to be affordable.(see ” Who Will Care For Us ? by Paul Osterman. Russell Sage Foundation 2017.) No shortage of things to do………….!! Peter F